Copyright Middlesex Academy of Business and Management 1

Application formPlease complete this form in BLOCK capitals and black ink

Applicants Details

Title: Mr. Miss Ms. Mrs. other__________ Family name:

First name:

Gender: Male Female Date of Birth: Marital Status:

Your full name as in your passport or travel document:

Current Nationality: Country of Birth:

Passport no: Passport expiry Date:

Visa no: Visa expiry Date:

Home Address (Permanent Overseas Address): Term-time Address (UK Address with post code):

Post code:

Mobile No: Mobile No:

Telephone No: Telephone No:

Fax No: Fax No:

E-Mail:

Next of Kin Emergency Contact Details

Name: Name:

Address: Address:

City: City:

Country: Post Code: Country: Post Code:

Contact No: Contact No:

E-mail: E-mail:

Course Details

Course Title:

Session: Sept / Oct Jan / Feb May / June Date:

Affix your Photograph

here

Middlesex Academy of Business and Management10 Oxford Road (Ground Floor)Wealdstone, HarrowMiddlesex HA3 7RG

www.mabm.co.uk2

English Language Qualification

If your first language is not English please supply copies of Academic English qualifications e.g. TOEFL, IELTS, etc

Educational Qualification

University, College School

(Name and Address)

Degree, Diploma Certificate, A-level

Professional QualificationSubject(s)

Pass Overall or

Fail Overall

Grades or Division or

Class

Date Started and

Date Awarded

Employment

Employers Name and Address

From Month &Year To Month &Year Position Held Full-time or Part-time Brief Outline of Duties

Sponsor Details (paying from overseas)

Name of Person: Company name:

Address: Telephone No:

Mobile No:

City: Country: E-Mail:

I enclose a bankers draft for __________ made payable to Middlesex Academy of Business and Management I confirm that a transfer of __________ has been made to MABMs account details below (Please mention student name or ID no and Course as the reference in all correspondence) I have attached 3 months sponsor Bank Statements

Bank name: HSBC Bank Account name: Middlesex Academy of Business & Management Sort Code: 40 09 06

Address: 23 Ripple Road, Barking, Essex IG11 7NW, UKAccount Number: 01708384SWIFT: MIDLGB2102F IBAN: GB76MIDL40090601708384

Ethnicity Monitoring

The Academy is committed to providing equal opportunities for all. To assist us with our confidential monitoring please choose one selection from A-E to indicate your ethnic group and tick the appropriate box to indicate your cultural background.

A. White British Irish Any other White background (Please specify)

B. Mixed White and Black Caribbean White and Black African White and Asian Any other Mixed background (Please specify)

C. Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background (Please specify)

D. Black or Black British Caribbean African Any other Black background (Please specify)

E. Chinese or other ethnic group Chinese Any other (Please specify)

Do you have a disability/special needs?

Yes No If yes, please specify details

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Personal Statement continue on a separate sheet if required

You are advised to complete this section with particular care and as fully as possible. Continue on a separate sheet if You should include:

Your reasons for choosing the award/course. The knowledge, skills and positions of responsibility you have obtained through your work and/or education (whether paid, voluntary or domes-

tic) which might be relevant to the award/course. The work experiences and/or personal developments which have been most important to you. The challenges facing you in your studies, work or personal career development. Your future career plans.

Referees:

Please give the details of two referees. One of these should be your line manager with your present and/or last employer.

1 Referees name: Your relationship with the referee:

Post held:

Address: Telephone No:

Mobile No:

Postcode: E-mail :

2 Referees name: Your relationship to with referee:

Post held:

Address: Telephone No:

Mobile No:

Postcode: E-mail :

Criminal Convictions

Do you have any criminal convictions? Yes No

If yes, please attach details in a separate sheet about your offence and conviction, including dates and court convicted at.

Have you checked the UKBA website at www.ukba.homeo ce.gov.uk?

(for latest information about studying in the UK including living costs in outer London) Yes No

How did you hear about the MABM?

Please specify

www.mabm.co.uk4

Student Letters (enrolment letters) to be sent

By Normal Post Will collect from MABM By International Courier

Terms and ConditionsEnrolment Procedure: Please visit Academy website at www.mabm.co.ukOnce we have processed your application form an acknowledgement letter will be issued and once we have processed payment an offer letter will be issued and sent to you according to your instructions.Summary terms and conditions of admission at MABM.

International students must pay the registration fee of 35 & CAS fees of 15 which are not refundable. For international students, a minimum deposit of 50% (or full fees) is required at the time of booking for courses. Balance 50% shall be paid before the commencement of second semester. Once confirmation of Acceptance for Studies (CAS) have been issued, confirming full-time student status, no refunds or course deferrals are permissible other than in the instance of visa refusal. Fees send from outside the UK should be paid by bank transfer, in person at academy can be by cheque, bank draft, cash, debit card or credit card (additional 3% charge apply). A charge of 50 will be made to students for all dishonoured cheque payment. All deposit cannot be transferred to other students or other courses. At the discretion of the MABM, course deferral may be allowed for students who are still overseas awaiting their student visa provided the Academy is informed of the delay no later than weeks the

scheduled course commencement date the student has booked for. An administration charge of 50 will be applied by the Academy per deferral. A maximum of two deferrals will be allowed. International students whose student visa application has been refused and do not wish to re-apply for visa, on receipt of written request with supported the official visa refusal letter and all original

documentation including the letter of enrolment and receipts issued by the Academy, be refunded, after 4 to 6 weeks, the fees paid less an administrative charge of 150. The Academy reserves the right to discuss any student at the time for unprofessional actions also to report offenders to their professional body. All information and prices provided on MABMs website and other promotional channels is believed to be correct at the time of printing but is subject to change at the discretion of the MABM. Changes

will be displayed on the MABMs notice board and / or on the website. Please see the prospectus or website for course entry qualifications. All fees quoted by MABM are inclusive of VAT. Fees are published separately for each term and are payable by all students studying at the time unless they have paid full fees prior to the new fees. Paying

a deposit does not prevent any fee increase being applied. Your details will where necessary be disclosed to UK regulatory and governmental organisations.

For full terms and conditions; please visit Academy website at www.mabm.co.uk or the Academy notice board in the reception area.

Data Protection Act (1998)

The Data Protection Act (1998) does not permit us to give information about an application to any person other than to the person who made the application.

DeclarationI declare that the information given is true in all respects. I understand that the Academy may pass my details to an appropriate third party (Awarding body, UKBA, etc.).

Signature of Applicant: Date:

If you have completed this form on behalf of an applicant, Please sign your name and relationship to the applicant.I declare that the information given is true in all respects.

Print name: Relationship:

Signature on behalf: Date:

All sections of this form must be completedand sent with the following:

Official Transcripts from educational institutions attended certificate Documentary evidence of your English Proficiency (e.g. IELTS, TOEFL) Passport copy Two recent passport-size photograph Personal Statement Two supporting references (at least one should be academic)

Please return this completed Application Form to:Admission Office Middlesex Academy of Business and Management10 Oxford Road (Ground Floor)Wealdstone, HarrowMiddlesex HA3 7RGUnited Kingdom

Office use only

Checklist: Registration fees & CAS fees Conditional offer letter Signed payment agreement Deposit received

Enrolment & CAS issued Full Terms & Conditions given Signed attendance policy

Date Received Approved Student Ref. No Signature Date